Intraparenchymal subependymoma: Case report and literature review.

BACKGROUND: Intracranial subependymomas are rare slow-growing benign tumors typically located in the ventricular system, accounting for 0.07-0.7% of all intracranial neoplasms. Intraparenchymal subependymoma is extremely rare lesions, imposing a challenging diagnosis and management. CASE DESCRIPTION: We describe a case of a supratentorial intraparenchymal mass on left occipital lobe in a 26-year-old woman with progressive headache and visual impairment. Differential diagnosis mainly included gliomas, neuronal-glial tumors, ependymoma, and subependymoma. Complete surgical resection was performed and histopathology analysis confirmed diagnosis of subependymoma. Despite its benign behavior the Ki67/MIB-1 labeling index assessed by immunohistochemistry was 5%. After 1 year of follow-up she was free of tumor recurrence. CONCLUSION: Intraparenchymal subependymoma is extremely rare tumors and literature review showed only 11 cases reported. In general, they are misdiagnosed as other tumors, so careful attention on clinical and radiological features must be taken when looking at a tumor close to the ventricular system, even though it does not have any obvious direct connection to it. Despite its benign nature, total removal must be attempted given that there are reports of recurrence, especially in partially removed tumors with high proliferation index. The role of adjuvant therapy is still limited and new treatment options are being developed as our knowledge on biological and molecular characteristics advances.

Tuberculum sellae meningiomas: surgical considerations.

We report our experience on the treatment of tuberculum sellae meningiomas (TSMs) regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome.

Tuberculum sellae meningiomas: surgical considerations / Meningiomas do tuberculo selar: aspectos cirúrgicos

We report our experience on the treatment of tuberculum sellae meningiomas (TSMs) regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome.

Apresentamos nossa experiência em 23 pacientes operados com meningiomas do tubérculo da sela, com enfoque na descompressão do nervo óptico e nos sintomas visuais do pós-operatório. Vinte e três pacientes com meningiomas do tubérculo da sela foram operados entre janeiro de 1997 e dezembro de 2008, através do acesso subfrontal via ostetomia supraorbital. Remoção do teto do canal óptico por via extra ou intradural foi realizada em 17 pacientes. Sintomas visuais no pré-operatório ocorreram em 21 pacientes, 2 eram assintomáticos. Melhora visual ocorreu em 10, permaneceu inalterada em 5 e piorou em 2 pacientes. No pós-operatório o campo visual normalizou-se em 17 pacientes, permaneceu inalterado em 4 e diminuiu em 2. Descompressão dos nervos ópticos foi realizada em 17 pacientes. Ressecção total dos meningiomas do tubérculo da sela foi possível em 19 pacientes. Abertura do canal óptico permitiu a manipulação do nervo óptico sem novos déficites.